Some current issues in the pharmacokinetics/pharmacodynamics of antimicrobials in intensive care

N. Petrosillo, C. M. Drapeau, M. Agrafiotis, M. E. Falagas

Research output: Contribution to journalArticle

Abstract

Infections, particularly those caused by resistant pathogens, are a common cause of morbidity and mortality in critically ill patients. However, the availability of effective antimicrobial agents is limited. Critical illness itself can influence the pharmacokinetic/pharmacodynamic (PK/PD) parameters of antimicrobials by altering their volume of distribution and the rate of their excretion and elimination and by impairing their penetration into tissues. Therefore, when designing a treatment regimen, the intensivist should consider and take advantage of antibiotic PK/PD properties. There is significant but inconclusive evidence that critically ill patients may benefit more when antibiotics with time-dependent action are administered in a continuous/prolonged infusion regimen. On the other hand, aminoglycosides exhibit a concentration-dependent pattern of killing and should be administered at high doses once daily or at extended intervals, and their levels in the plasma should by strictly monitored to avoid both underexposure and toxicity. The problem of antimicrobial resistance now involves agents traditionally considered reliable in that aspect, such as vancomycin. Strict monitoring of vancomycin MIC for methicillin-resistant Staphylococcus aureus and the prudent use of the available alternative agents as well as de-escalation strategies might be reasonable strategies for dealing with this problem.

Original languageEnglish
Pages (from-to)509-524
Number of pages16
JournalMinerva Anestesiologica
Volume76
Issue number7
Publication statusPublished - Jul 2010

Fingerprint

Critical Care
Critical Illness
Pharmacokinetics
Vancomycin
Anti-Bacterial Agents
Aminoglycosides
Methicillin-Resistant Staphylococcus aureus
Anti-Infective Agents
Morbidity
Mortality
Infection
Therapeutics

Keywords

  • Anti-infective agents
  • Intensive care
  • Pharmacokinetics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Some current issues in the pharmacokinetics/pharmacodynamics of antimicrobials in intensive care. / Petrosillo, N.; Drapeau, C. M.; Agrafiotis, M.; Falagas, M. E.

In: Minerva Anestesiologica, Vol. 76, No. 7, 07.2010, p. 509-524.

Research output: Contribution to journalArticle

Petrosillo, N. ; Drapeau, C. M. ; Agrafiotis, M. ; Falagas, M. E. / Some current issues in the pharmacokinetics/pharmacodynamics of antimicrobials in intensive care. In: Minerva Anestesiologica. 2010 ; Vol. 76, No. 7. pp. 509-524.
@article{9850eed37792496d98335c9c666d9478,
title = "Some current issues in the pharmacokinetics/pharmacodynamics of antimicrobials in intensive care",
abstract = "Infections, particularly those caused by resistant pathogens, are a common cause of morbidity and mortality in critically ill patients. However, the availability of effective antimicrobial agents is limited. Critical illness itself can influence the pharmacokinetic/pharmacodynamic (PK/PD) parameters of antimicrobials by altering their volume of distribution and the rate of their excretion and elimination and by impairing their penetration into tissues. Therefore, when designing a treatment regimen, the intensivist should consider and take advantage of antibiotic PK/PD properties. There is significant but inconclusive evidence that critically ill patients may benefit more when antibiotics with time-dependent action are administered in a continuous/prolonged infusion regimen. On the other hand, aminoglycosides exhibit a concentration-dependent pattern of killing and should be administered at high doses once daily or at extended intervals, and their levels in the plasma should by strictly monitored to avoid both underexposure and toxicity. The problem of antimicrobial resistance now involves agents traditionally considered reliable in that aspect, such as vancomycin. Strict monitoring of vancomycin MIC for methicillin-resistant Staphylococcus aureus and the prudent use of the available alternative agents as well as de-escalation strategies might be reasonable strategies for dealing with this problem.",
keywords = "Anti-infective agents, Intensive care, Pharmacokinetics",
author = "N. Petrosillo and Drapeau, {C. M.} and M. Agrafiotis and Falagas, {M. E.}",
year = "2010",
month = "7",
language = "English",
volume = "76",
pages = "509--524",
journal = "Minerva Anestesiologica",
issn = "0375-9393",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "7",

}

TY - JOUR

T1 - Some current issues in the pharmacokinetics/pharmacodynamics of antimicrobials in intensive care

AU - Petrosillo, N.

AU - Drapeau, C. M.

AU - Agrafiotis, M.

AU - Falagas, M. E.

PY - 2010/7

Y1 - 2010/7

N2 - Infections, particularly those caused by resistant pathogens, are a common cause of morbidity and mortality in critically ill patients. However, the availability of effective antimicrobial agents is limited. Critical illness itself can influence the pharmacokinetic/pharmacodynamic (PK/PD) parameters of antimicrobials by altering their volume of distribution and the rate of their excretion and elimination and by impairing their penetration into tissues. Therefore, when designing a treatment regimen, the intensivist should consider and take advantage of antibiotic PK/PD properties. There is significant but inconclusive evidence that critically ill patients may benefit more when antibiotics with time-dependent action are administered in a continuous/prolonged infusion regimen. On the other hand, aminoglycosides exhibit a concentration-dependent pattern of killing and should be administered at high doses once daily or at extended intervals, and their levels in the plasma should by strictly monitored to avoid both underexposure and toxicity. The problem of antimicrobial resistance now involves agents traditionally considered reliable in that aspect, such as vancomycin. Strict monitoring of vancomycin MIC for methicillin-resistant Staphylococcus aureus and the prudent use of the available alternative agents as well as de-escalation strategies might be reasonable strategies for dealing with this problem.

AB - Infections, particularly those caused by resistant pathogens, are a common cause of morbidity and mortality in critically ill patients. However, the availability of effective antimicrobial agents is limited. Critical illness itself can influence the pharmacokinetic/pharmacodynamic (PK/PD) parameters of antimicrobials by altering their volume of distribution and the rate of their excretion and elimination and by impairing their penetration into tissues. Therefore, when designing a treatment regimen, the intensivist should consider and take advantage of antibiotic PK/PD properties. There is significant but inconclusive evidence that critically ill patients may benefit more when antibiotics with time-dependent action are administered in a continuous/prolonged infusion regimen. On the other hand, aminoglycosides exhibit a concentration-dependent pattern of killing and should be administered at high doses once daily or at extended intervals, and their levels in the plasma should by strictly monitored to avoid both underexposure and toxicity. The problem of antimicrobial resistance now involves agents traditionally considered reliable in that aspect, such as vancomycin. Strict monitoring of vancomycin MIC for methicillin-resistant Staphylococcus aureus and the prudent use of the available alternative agents as well as de-escalation strategies might be reasonable strategies for dealing with this problem.

KW - Anti-infective agents

KW - Intensive care

KW - Pharmacokinetics

UR - http://www.scopus.com/inward/record.url?scp=77954981821&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954981821&partnerID=8YFLogxK

M3 - Article

C2 - 20613692

AN - SCOPUS:77954981821

VL - 76

SP - 509

EP - 524

JO - Minerva Anestesiologica

JF - Minerva Anestesiologica

SN - 0375-9393

IS - 7

ER -